Project Summary The goal of this study ?Preventing Early Childhood Obesity through a Home-Based Parenting Intervention,? is to evaluate the impact of a home-based childhood obesity prevention intervention called Family Spirit Nurture (FSN) on mother?s feeding practices and responsive feeding behaviors as well as infant and toddler nutrition, physical activity (PA), and growth patterns through a randomized controlled trial. The study population is the White Mountain Apache (Apache) Tribe and Navajo Nation, who have a 35-year history of pioneering research in collaboration with the Johns Hopkins Center for American Indian Health (JHCAIH). FSN builds on the evidence based Family Spirit parenting intervention, developed and evaluated by JHCAIH. By integrating comprehensive infant and young child feeding (IYCF), diet, and PA components to the Family Spirit intervention (making it Family Spirit-Nurture [FSN]), FSN is poised to lower obesity risk among American Indian (AI) children. Apache and Navajo expectant mothers (< 28 weeks gestation) aged 14-22 (N=338) will be randomized to receive the FSN intervention +Optimized Standard Care (OSC) or OSC alone. FSN consists of 36 comprehensive home-based curricular lessons taught in 60-minute visits from 28 weeks gestation through 18 months postpartum. OSC consists of transportation assistance to clinic- based prenatal and well-baby visits and referrals to community resources. Primary study aims are to compare the efficacy of FSN +OSC vs. OSC alone on: 1) mothers? feeding practices and behaviors; 2) infant and toddlers? diet; 3) infant and toddlers? PA; and 4) infant and toddlers? BMI z-scores. We will evaluate study aims through a mixed method assessment conducted at nine time points: baseline, birth, 2, 4, 6, 9, 12, 18, 24 months postpartum. This proposal is urgent, innovative and has potential for significant impact because: 1) AI infants, toddlers and youth have the nation?s highest rates of obesity; 2) FSN is designed to prevent obesity in early childhood by promoting parenting practices that reduce obesity risk while simultaneously addressing primary caregiver?s psychosocial and home environment factors; and 3) FSN builds on the Family Spirit intervention which was successfully evaluated in Apache and Navajo communities then scaled to 60+ additional tribal communities. If study aims are met, we will demonstrate the efficacy of a new Community Health Worker model for obesity risk reduction?a current necessity to overcome human resource and health system deficits in low income, rural and, often, culturally diverse communities.